Biomedical subjects

Chantale Dumoulin

Publications and source records attributed to Chantale Dumoulin.

5 recordsLinked to original sources

PubMed2006

Postnatal pelvic floor muscle training for preventing and treating urinary incontinence: where do we stand?

PURPOSE OF REVIEW: Postnatal pelvic floor muscle training aims to rehabilitate the pelvic floor muscles. To be effective, a certain exercise dosage must be respected. Recent trials evaluated the effect of different programs on prevention/treatment of urinary incontinence immediately after delivery and in treatment of persistent incontinence. RECENT FINDINGS: Only three systematic reviews, six trials, and four follow-up studies have been published in the past two decades. High heterogeneity in postnatal pelvic floor muscle training programs is observed throughout the literature, making comparisons difficult. In the prevention/treatment of postnatal urinary incontinence immediately after delivery and in persistent incontinence, supervised intensive programs prove more effective than standard postnatal care. Longer-term results have yet to show advantages for postnatal training programs. SUMMARY: Although a certain exercise dosage must be respected for a postnatal pelvic floor muscle training program to be effective, a few randomized controlled trials present such dosage. Randomized controlled trials should study the effect of supervised, intensive training protocols with adherence aids. As standard care does not seem to reduce the prevalence of postnatal urinary incontinence, obstetrics services must address delivery of postnatal pelvic floor muscle training.

Female↗

PubMed2005

Urinary incontinence after stroke: does rehabilitation make a difference? A systematic review of the effectiveness of behavioral therapy.

This study uses a comprehensive review of the literature to assess the scientific evidence for the effectiveness of behavioral therapies to treat urinary incontinence (UI) post stroke. Evidence for the different behavioral therapies was critically appraised to achieve a level of evidence based on Foley's classification of levels of evidence. Only four randomized clinical trials (RCTs), one cohort study, and recommendations from three clinical practice guidelines were found. There is limited evidence that bladder retraining with urge suppression in combination with pelvic floor exercises results in reduction of UI in male individuals with stroke. Further research is urgently needed to elucidate clinical recommendations about the efficacy of behavioral approaches.

Behavior Therapy↗

PubMed2004

Reliability of dynamometric measurements of the pelvic floor musculature.

AIMS: The objective of this study was to evaluate the reliability of strength and endurance dynamometric measurements of the pelvic floor musculature (PFM). MATERIALS AND METHODS: Twenty-nine female participants, primipara and multipara, aged between 27 and 42 and presenting different severity levels of stress urinary incontinence (SUI), participated in the study. They were evaluated using a new pelvic floor dynamometer, an instrumented speculum based on strain-gauged technology. Strength and endurance evaluations were repeated in three successive sessions, each followed by a 4-week period. Maximal strength values were recorded at three dynamometer openings (5 mm, 1 cm, and 1.5 cm between the two dynamometer branches). The maximal rate of force development (MRFD) and percentage of strength lost after 10 and 60 sec were computed from the endurance trial. The generalizability theory was applied to estimate the reliability of the PFM measurements. The reliability was quantified by the index of dependability and the corresponding standard error of measurement (SEM) for one and the mean of three trials performed in one session for the strength measurements and one trial completed in one session for the MRFD and endurance measurements. RESULTS: For the maximal strength measurements, the largest coefficient of dependability was obtained at the 1 cm opening, with a value of 0.88. The corresponding SEM reached 1.49 N. The reliability of the MRFD was also very good with a coefficient of 0.86 and an SEM of 0.056 N/sec. The reliability was minimally affected by the number of trials. The strength loss measurements at 10 and 60 sec were unreliable, with coefficient values of 0.38 and 0.10, respectively. CONCLUSIONS: The results of the present study indicate that the reliability of the strength parameters (maximal strength and MRTD measurements) was high enough for future investigations on pelvic floor rehabilitation programs.

Adult↗

PubMed2004

Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence. METHODS: This was a single-blind randomized controlled trial. Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or control non-pelvic floor rehabilitation (n = 20). The primary outcome measure consisted of a modified 20-minute pad test. The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements. RESULTS: Two patients dropped out, leaving 62 for analysis. At follow-up, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups (all P <.002), whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group. CONCLUSION: Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence.

Abdominal Muscles↗

PubMed2003

Development of a dynamometer for measuring the isometric force of the pelvic floor musculature.

AIMS: The aim of this study was to design and develop a dynamometer providing a direct measurement of pelvic floor muscle (PFM) strength. MATERIALS AND METHODS: Two pairs of strain gauges were mounted on the moveable branch of a dynamometric speculum allowing measurements at different vaginal apertures. Linearity, repeatability, independence of the site of application of the resultant force to the lower branch of the speculum and hysteresis were tested by means of in vitro calibration studies. RESULTS: The linearity proved excellent over a range of 0-15 N with regression coefficients close to unity between imposed loads and voltage outputs. The slopes and intercepts of the regression lines were not significantly different between repeated sessions, indicating the high reliability of these in vitro measurements. The slopes and intercepts of the calibrations, using the same repertoire of loads imposed at three locations on the moving branch of the dynamometer, were not significantly different, confirming that the force measurement is independent of the site of the force application. Hysteresis was considered to be minimal. CONCLUSIONS: This study demonstrates that the dynamometer provides reliable measurements. The new device thus appears to have conceptual and measuring advantages over conventional methods and seems to be a very promising instrument for measuring pelvic floor strength.

Calibration↗